Toddlers with GERD - alternatives to Zantac?

[Cloth4Colin]

DS was recently diagnosed with GERD. FINALLY, we got answers as to why he was throwing up on a weekly basis. At it's worst, he was waking between 2 and 4am and being sick every twenty minutes for hours. DH and I were freaked out - we kept getting a "virus" diagnosis, until we insisted that it was way too peculiar for a 2 year old to get five stomach viruses in five weeks.

DS's doctor has suggested prescription medication, but we'd like to try some alternatives first. We've found that keeping him from eating and drinking 2 hours before bed had greatly improved the situation - in fact, he hasn't had an episode in two weeks!! Milk, citrus, and greasy/fatty foods seem to be the main culprit, so we are limiting those foods throughout the day as well.

Are there any other mamas here dealing with GERD in their toddlers? What are some tips, suggestions on managing it? If your child takes meds, are there any side effects I should be aware of?

TIA!

[horselady]

We've had great success with chiropractic care treating GERD. Aside from the adjustments the chiro was also able to help me eliminate foods causing the problem by looking at our food diary. He was able to see behavioral connections to foods i hadn't noticed. We had immediate, amazing results with this but I have heard of a lot of other natural ways of dealing with GERD.

[XanaduMama]

I would cut out ALL the dairy (and maybe the citrus, soy, etc too). ds was on Axid (same as Zantac but tastes much better, acc to our ped--still pretty yucky though) for a couple months as an infant and we noticed no side effects (though who can tell with a preverbal infant!). The only listed side effects are stuff like nausea--nothing serious, as far as I remember. GERD can cause long-term damage to the esophagus if it's untreated, so meds are often warranted in this situation. But the other strategies help too, of course.

[RootBeerFloat]

GERD in most children is caused by food allergies. (There may also be structural issues, but they are rare and would likely have presented from birth.) You will not hear this from many doctors, but it is TRUE! We have been around the bend and back with my dd on this issue, she had GERD from birth (and, not coincidentally, was formula fed due to a major milk production issue). If you identify and eliminate the food allergies and work on healing his gut, the GERD will go away.

According to my acupuncturist, the time period between 3-5 in the morning is associated with the small intestine. If there is waking (which dd does) during this time, it indicates irritation there, such as caused by food allegies.

GERD is to be taken seriously it can really damage a person's health and create lifelong health and eating issues.

I would eliminate major allergens from both of your diets (assuming you're still nursing). It is hard and will take up to a month for all of the offending foods to clear your systems, so be patient. I would also start a diary of what he's eating every day and how the wakeups/vomitting is and also any kind of runny nose, skin rashes, etc to give you a picture of what foods are causing the problem.

In addition, you need to pay attention to his gut health. Good quality probiotics and digestive enzymes are a must over the next several months if not years. Additionally, eat foods that are healing to the gut, like homemade bone broths (the gelatin is very nourising to the gut), also apple pectin is soothing to the gut. Easily digestible foods are best; also avoiding as much processed food as possible.

After several months (think 6 mo to a year), the gut will heal and become strong again. He may be able to manage small/occasional amounts of allergenic foods then.

The healing the gut tribe here is loaded with moms dealing with just this sort of thing.

Also, I've learned through dealing with dd that I have a ton of food allergies myself that have symptoms that I've never recognized. It may be wise to treat both of you at the same time.

[afishwithabike]

I made an info sheet for a former friend regarding this topic. I keep it around for situations like yours.


Here is the reference guide that I have made.

Healing Infant reflux:

What Mom can do:
Eat a varied diet and make sure mom gets plenty of vitamins and fats and proteins from her food. An alternative nutritionist can help with this.
Ginger can be ingested by the breastfeeding mother in many forms. Her body will break it down into very digestable enzymes for baby. It can induce sweating, thereby expelling toxins and cleansing the whole system.
Try Chiropractic care.
Chirpractors are nerve doctors trained to deal with the fine mechanical problems in the nervous system. What a chiropractor does is check the spine for any distortion (also called subluxation) caused by the bones of the spine moving out of line or position. This distortion, which is often painless, irritates the spinal nerves, which in turn causes dis-ease within the body in some way — often manifesting itself in a person's physical and emotional health.
"Infant spinal nerve problems arise from two major things: The trauma of the birth process and the toddler phase," explained Dr. Marsh. "The birth process is very traumatic," agreed Dr. Michael Malik, a chiropractor in Barrington, "and can certainly cause enough pressure for a subluxation to occur." Plus, once the baby is born, "its nervous system is constantly changing. Babies sit up, lean their head to one side or the other and fall over all the time," said Dr. Malik.

Infant chiropractic care is all about prevention
EAST BAY - A few days after she was born, Shannon Ganser was diagnosed with acid reflux disease. Her pediatrician prescribed the drug Zantac.Shannon began taking the drug, but her parents weren't comfortable having their baby dependent on medication. They brought her to Dr. Ron Marsh, a chiropractor in Portsmouth, when she was just 5 weeks old.
Six week later, Shannon was taking half the medication prescribed. After 12 weeks she was off the prescription entirely.
Shannon is now 14 months old, and she sees Dr. Marsh twice a month for regular adjustments. "She's a really healthy kid," said Kelly Ganser, Shannon's mother. "Actually, she's the healthiest kid I know."
Advice from other mothers who have been through this:
Until she finds a med that will work for the baby such as Prilosec or Prevacid, the baby needs to be given 1/2 teaspoon Mylanta about 4 times a day, preferably 30 mins or so before a feeding. The Mylanta will start to work immediately. Zantac, Prilosec, and Prevacid will take up to a week for full results. I know that these meds are not ideal, but sometimes when it gets to that point where you have a baby in pain and stressed out mother, the meds are the best thing you can do until you find a possible cause for the reflux, such as allergies, or until baby outgrows the reflux if it is not allergy-related.
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Reflux is a terrible thing to deal with in an infant. The stress of dealing with it is beyond overwhelming. I gave my Daughter mylanta (1ml) and that helped A LOT! It didn't cure it or stop all the crying but it got to the point where I would just shake the mylanta bottle and my daughter would calm down, as if she knew that relief was on the way. My daughter didn't spit up much but I suspect that she was in serious pain from the milk coming back up her throat. I did eventually try zantac but my daughter hated the taste so much that she would spit it all out. I also tried gripe water (before any other meds) which helped just a little but not enough for a really noticable effect.

One other thing I did to help was pump a little before feeding my daughter. I had an overactive letdown which I think cause a lot of problems for her both before and after feeding.

One thing I regret not trying sooner is chiropractic. I really believe that would have helped. I started taking my daughter to a pediatric chiro recently since she has never been a good sleeper and I am really starting to see improvements. I used to suffer from really bad reflux but it occurred to me that it pretty much stopped after I started regular chiro care.

Ginger Root
Ginger Root is an old healer's remedy that builds, thickens and grounds one's energy field. It is an invaluable remedy for healers and those who are learning the craft of healing. For the rest of us, it is also a great blood and kidney purifier, and immune system stimulator.
In the Orient, it is common to drink a tea brewed from fresh ginger after meals in order to ease digestion. Just pour boiling water into a cup containing a little grated ginger. Let it steep for a few minutes then add honey and lemon juice to taste.

GINGER ROOT FACT SHEET
Ginger brings relief to digestions troubled by motion sickness, morning sickness, and other causes; also an important circulatory remedy. Excellent remedy for dysentary. Highly effective for digestive complaints such as colic, nausea, gas, and indigestion. It is also antiseptic, making it valuable in treating gastrointestinal infections, including some types of food poisoning. Stimulates the circulation and helps high blood pressure. Increases sweating and helps reduce body temperature in high fevers. Aids respiratory conditions such as coughs, colds, and flu with its warming, soothing properties.
Fresh ginger is a typical yang food because it can stimulate many activities in the body. For example, it can speed blood circulation and secretion of stomach fluids, stimulate the intestinal tract, and promote digestion.
Ginger contains the active ingredients gingerol and shogoals. It is extremely effective for the treatment of nausea and digestion. The gingerol and shogoal neutralize stomach acids and enhance the secretion of digestive juices, stimulates appetite and conditions digestive tract muscles. Ginger contains anti-inflammatory properties that have been confirmed by medical research.

Chamomile (also known as German chamomile)
The healing properties of chamomile have been acknowledged for over 2,000 years. It is a member of the daisy family and is native to both Europe and Western Asia. It is most commonly used for gastrointestinal complaints. The herb contains a complex compound of chemicals that work both individually and collectively on the body. To sooth a troubled stomach, one chemical within camomile speeds the mending of torn tissue to heal any ulceration, while another shrinks the swollen stomach tissue that creates pressure on nerve endings and yet another kills infection, stopping bouts of food poisoning or intestinal flu. Chamomile is usually taken as a tea however it can also be taken in tablet or capsule form.
Chamomile can be very beneficial as a cure for the following:

Colic
Conjunctivitis
Diarrhoea
Eczema
Indigestion
Insomnia
Heartburn
Mouth ulcers
Peptic ulcers
Ulcerative colitis

Chamomile tea is a favorite herbal tea that many use if they have trouble sleeping. It has natural sedative, antiinflamatory and antispasmodic properties so is also good for cramps. Due to it’s calming benefits it is often used to help relieve anxiety. It is rich in essential oil and can help the digestive system function properly. Chamomile is also very good for your skin and you can wet a cloth in the tea and use it as a skin cleanser or compress.
Camomile [Gr.,=ground apple], name for various related plants of the family Asteraceae, especially the perennial Anthemis nobilis, the English, or Roman, chamomile, and the annual Matricaria chamomilla, the German, or wild, chamomile. Both are European herbs with similar uses. The former has an applelike aroma and is the chamomile most frequently grown for ornament (often as a ground cover) and for chamomile tea, made from the dried flower heads, which contain a volatile oil. The oil from the similar flowers of the wild chamomile was most often used medicinally, particularly as a tonic; today its chief use is as a hair rinse. Chamomile is classified in the division Magnoliophyta , class Magnoliopsida, order Asterales, family Asteraceae.

Rule out any possible allergies:
Late last year, the results of an extensive Italian study involving diet, environment and infant allergies came across my desk. The study compared more than 300 high-risk infants with multiple types of intervention. The focus of the intervention was in three areas:
mother's diet;
infant's diet;
environmental factors.
The mothers in the intervention group's dietary modifications included:
No more than six ounces of milk per day were given to nursing mothers.
No eggs were allowed in the diet of nursing mothers.
The infants in the intervention group's dietary modifications included:
No solid foods were introduced until the 5th month of life.
Solid foods were introduced at a rate of no more than one new food every 7-10 days.
Only low-allergy solid foods were given from the 5th through 12th months.
The solid foods that were considered low allergy included: cereal from rice, corn or tapioca; vegetables excluding all beans and tomatoes; olive oil; no dairy products except for Parmesan cheese; no eggs; turkey, lamb and rabbit were allowed, but no beef, pork, chicken or fish.
From the 12th month to the 24th month, all foods were introduced except eggs, nuts and cocoa, which were not given until after two years of age.
The environmental controls for the intervention group included:
no smoking in the child's house;
no cats, dogs or other pets with fur;
weekly carpet cleaning; * isolation from nurseries and preschool until two years of age.
Article written by Dr. Alan Greene:
Usually the first place to start is with looking at how the baby is fed. Decreasing the volume and increasing the frequency of feedings is sometimes enough to deal with reflux. If the baby is already drinking from a bottle, thickening the feedings with one tablespoon of rice cereal per ounce of feeding is an option to be discussed with your physician. This can mechanically reduce the amount of milk sloshed back up the esophagus. Some studies suggest that this decreases both spitting up and crying in babies with reflux. However, this does provide extra calories to your baby, and it may also make it harder for your baby to know when he or she has had enough to eat.
Food allergies may also cause reflux. The most common culprits are cow’s milk and soy proteins in formulas. Foods in mother’s diet can also affect breastfeeding babies. Cow’s milk is the most common cause of this, but other foods such as soy, egg, and peanuts could also be a problem. For most babies, I prefer briefly trying to feed the baby without these exposures to see if this solves the reflux problem before trying any medication. I suspect that tobacco, coffee, and caffeine in breastmilk and secondhand smoke in the air also worsen reflux in babies, but I have not seen proof of this.
Because reflux is usually a mechanical problem, and because babies can’t adjust their position as well as you and I can, positioning is an important part of reflux treatment. Sitting usually is the worst position for reflux. Minimizing the use of carriers and swings that keep small babies in a sitting position makes a big difference for some babies. When the baby is awake, carrying the baby upright, and encouraging spending time on the tummy are associated with the least reflux for most babies. Babies should not be put to sleep on their tummies, but tummy-time is great for babies when they are awake.
A number of medicines have been used to treat reflux.
Antacids come quickly to mind. Although these seem gentle, those available in liquid form today usually rely on magnesium or aluminum. These silvery metals could cause diarrhea or constipation in babies, and their long-term effects are not well understood. I prefer magnesium to aluminum.
Another class of medicines, called H2RA’s, decrease acid production in the stomach. Many of them are familiar because of their use in treating reflux or peptic ulcer disease in adults. They do not decrease the reflux itself, but make the sloshed liquid less acidic, and thus less likely to cause problems. These medicines commonly used in children include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and one of the medicines you asked about, ranitidine (Zantac). Tagamet and Axid are not approved by the FDA for children under 16. Pepcid and Zantac are now approved for children, even infants, although they were not at the time of your question. Zantac is a strong drug. It has brought relief to many babies. It is well tolerated by most children. Headaches, sometimes severe, are the most commonly reported side effects in those old enough to describe them. The most serious side effects, heart rhythm abnormalities, can be caused by any medicine in this class – but they are quite rare. Because there has been a lot of experience with these medications, they are usually the first to be used in babies with reflux.
Proton pump inhibiters are a more recent development. They are more powerful at blocking acid production. You might recognize some of the names from television ads. Those commonly used in children include esomeprazole (Nexium – the Purple Pill), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex). Nexium, Prevacid, Protonix, and Aciphex are not approved by the FDA for use in children. Prilosec is not approved for use under age 2.
Another class of medicines, called prokinetic agents, are supposed to help speed along whatever is in the stomach, and to tighten the valve at the top of the stomach so acid is less likely to slosh up. Propulsid falls into this category, but thankfully is no longer used. It was extremely popular for several years, but when looked at carefully was found to have killed 80 of those taking it. Other prokinetic medicines used in children include bethanechol (Urecholine), metoclopramide (Reglan), and the antibiotic erythromycin. Urecholine has not been approved by the FDA for use in children. Nor has Reglan been approved for use in children, except for emergencies. Erythromycin has been approved by the FDA for children, but not for treating reflux in them.
You will have noticed that many of these drugs have not been approved by the FDA for use in children. "Safety and effectiveness in children have not been established." Do they really work? Are they really safe? We really don't know. Most of what we do know about both drugs has been learned from their use in adults. This does not mean that your physician was wrong to prescribe them. Of the two unapproved drugs that your physician chose, Zantac went on to be approved after research in children found it to be both safe and effective; Propulsid was recalled after it was found to be dangerous.
As of the time of your question, of the 80 drugs most commonly used to treat newborns and infants, only 5 had been tested and approved for use in children! (American Medical News, June 2, 1997) The situation is now improving, but we still have a long way to go. Because children of each age represent a small market share, because tailoring trials to specific age groups is very expensive, because parents are understandably reluctant to let their children participate in clinical trials, because pharmaceutical companies are reluctant to risk liability for side effects, and because many of us don't take little children and their needs seriously -- our knowledge of the safety and effectiveness of drugs in small children is unconscionably inadequate.
In the current environment, prescribing unapproved drugs is common and often vital. But let's not settle for the current environment. Let's encourage the FDA and the pharmaceutical industry to learn more about the effects of commonly used drugs on children.
In the meantime, I would only use these excellent medications if the symptoms from the reflux are themselves significant. Last week a baby I take care of was proven to have episodes of reflux that produced prolonged apnea spells (not breathing) and periods of slow heart rate. For this baby, the benefits of strong medicines clearly outweigh the risks. For most babies, though, the impact of reflux is much less severe.
I've begun to hear about doctors who prescribe Zantac for almost any fussy baby. This is unwise. While side effects are uncommon, this is a strong drug that alters the normal secretions of the cells of the stomach wall. I agree with thoughtful use of Zantac. It should not be dispensed like candy.
The human body is amazing. Even as we consider the options for treating reflux, your baby is already busy doing the real work. Silently, the muscles mature and coordinate. The great majority of babies with reflux cure themselves, with nothing but a tincture of time and some thoughtful, gentle relief.


Alan Greene MD FAAP

[sbgrace]

Well, for 18 months I have been doing everything right with my son in terms of gut healing and eliminating allergens (no soy, dairy, wheat, nuts, legumes, corn, rice, nuts, etc.). He gets cranial, chiropractic, reflexology (and accupressure) therapy also for 18 months. I've tried herbal treatments (including ginger). He is still a refluxer at 3 years.
However, sometimes it is food issues and I think focusing on that and enzymes can be very helpful. Other thoughts would be yeast or candida issues. Culturelle probiotic is easy to get a hold of and can't hurt him.
Without reflux medication my son spit up blood and screamed when he swallowed. So I just want to say that sometimes the meds are needed though I hope you can avoid them. Sometimes you can do all the stuff mentioned above and still have issues. Sometimes it is structural. I hate the meds. But my son needs them. I hate that. But he does and no alternative I've tried has helped.

Ginger is most promising to me as far as my research though it didn't cure us (and fresh has a kid unfriendly taste though my guy still takes it). If it doesn't help the reflux like it does for some it should help digestion. I did see a pubmed study, though, where adult pregnant women were treated with ginger for morning sickness and the only drop-outs in the study did so because of reflux issues related to the ginger. That study has me a bit concerned.
Low carb diets can be successful in treating it for some people (and I did try that but I can't recommend it with a child; tough diet for a kid).

If you do need the medication use digestive enzymes (houston's are good). The worst thing about them is the impeded digestion due to lower stomach acid so do use enzymes. The best thing is your child won't be sick or in pain.

Oh, the thing that has helped us so much is elevating the head of the bed 6 inches.

[ben'smama]

I only have a moment...but I wanted an alternative to meds too, so we cut out (ds and myself, as it seemed that stuff was passing through my milk) all citrus, tomato, peppermint (which I was giving to him to CALM his tummy and aid digestion!) chocolate, and alcohol...I think there is one other thing that might have already been posted... We haven't have any vomiting since starting the diet. I know I am writing way after your first post, so i hope your little one has improved!

[Gitti]

Originally Posted by Cloth4Colin

DS was recently diagnosed with GERD.

Just one question, is this child vaccinated?
If so, please watch this DVD.

Watch the whole DVD (it starts out slow...)
The main part is about autism, BUT it talks a LOT about the gut issue. Especially in part 2 - maybe you want to start there. And part 4 a doctor talks about all the gut issues and how kids are being misdiagnosed.



http://www.chem.cmu.edu/wakefield/

[USAmma]

Hi,

I just wanted to caution you that this may be just the start of your journey in finding answers for your toddler's health issues. You have some good advice here-- I would not rule out food allergies either. Be aggressive about treating this and eliminating the possible causes. I'm so glad you are on the road to better health for your child.

[Annikate]

Wow, you've gotten a ton of great info!

Here's some more. Check out the link in my siggy.